Probe vs PhilHealth not enough, reforms needed — Garin

MANILA, Philippines — The investigation on the fraudulent schemes at the Philippine Health Insurance Corp. (Philhealth) is not enough as reforms are needed to improve the agency’s system, former Health Secretary Janette Garin said Wednesday.

In a press conference in Quezon City, Garin explained that the probe on PhilHealth’s fraudulent claims may fizzle out, leaving the agency’s mafia to continue using funds for “ghost” treatments.

“Maraming specialista ang may alam but it should not stop there dahil yung imbestigasyon, medyo humihina. Kapag may investigation kanya-kanya muna ang tago and after a few months kung wala sa ere nagbabalikan [ang mafia],” Garin said in a press briefing on PhilHealth’s so-called “ghost” treatments on Wednesday.

(Many specialists are aware of the fraudulent schemes, but the probe should not stop there. The investigation may weaken later because people generally lay low if there is an investigation.)

Earlier, Garin revealed that some PhilHealth doctors and officials had been allegedly using funds to pay for “ghost” treatments for patients.

READ: Garin says PhilHealth had been paying for a lot of ‘ghost’ treatments

Garin also said the reforms that they proposed to PhilHealth should be implemented. She lamented that the agency’s health officials failed to follow through.

“Is Congress investigation the only solution? No? But, the actual reforms we initiated despite all odds,” Garin said.

Stop payment scheme

During her stint as Department of Health (DOH) chief, Garin implemented a “stop payment scheme” at PhilHealth which stops funding for healthcare providers if anomalies are detected.

“Kapag ikaw ay healthcare provider at merong nakitang biglang taas [sa payment] automatic ihihinto ang bayad sa inyo ng PhilHealth (If you are a healthcare provider and we see a sudden increase in payments, we will automatically stop the payments),” Garin said.

The stop payment scheme stemmed from unresolved and “comatose” cases in PhilHealth, Garin said.

“When I reviewed all the cases, ang dami pong na-comatose. ‘Yung mga hospital na may kaso at yung mga doctor na paulit-ulit na perpetrators ng fraud. ‘Tila ang tagal. Tulog ang kaso sa Philhealth. ‘Bat ba ang daming kasi na-comatose sa loob ng Philhealth?” Garin said.

However, after Garin stepped down as Health chief, she said she found out that PhilHealth board members are only charging doctors and officials who are involved in fraud scandals.

“Ang nangyari lahat ng may kasalanan meron lang kakausapin sa loob gagawa ng papel na ifi-fine na lang. Walang suspension, walang revocation ng accreditation. Magbabayad ka lang ng fine,” she said.

(What happens is that they talk to some insiders and they are fined. There is no suspension or revocation of accreditation. The fine settles everything. (Editor: Eden Estopace)